Prognostic value of axillary nodal ratio after neoadjuvant chemotherapy of doxorubicin/cyclophosphamide followed by docetaxel in breast cancer: A multicenter retrospective cohort study

Se Hyun Kim, Kyung Hae Jung, Tae Yong Kim, Seock Ah Im, In Sil Choi, Yee Soo Chae, Sun Kyung Baek, Seok Yun Kang, Sarah Park, In Hae Park, Keun Seok Lee, Yoon Ji Choi, Soohyeon Lee, Joo Hyuk Sohn, Yeon Hee Park, Young Hyuck Im, Jin Hee Ahn, Sung Bae Kim, Jee Hyun Kim

Research output: Contribution to journalArticle

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Abstract

Purpose The purpose of this study is to investigate the prognostic value of lymph node (LN) ratio (LNR) in patients with breast cancer after neoadjuvant chemotherapy. Materials and Methods This retrospective analysis is based on the data of 814 patients with stage II/III breast cancer treated with four cycles of doxorubicin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical significance of LNR (3 categories: low 0-0.20 vs. intermediate 0.21-0.65 vs. high 0.66-1.00) using a Cox proportional regression model. Results A total of 799 patients underwent breast surgery. Pathologic complete response (pCR, ypT0/isN0) was achieved in 129 patients (16.1%) (hormone receptor [HR] +/human epidermal growth factor receptor 2 [HER2] -, 34/373 [9.1%]; HER2+, 45/210 [21.4%]; triple negative breast cancer, 50/216 [23.1%]). The mean numbers of involved LN and retrieved LN were 2.70 (range, 0 to 42) and 13.98 (range, 1 to 64), respectively. The mean LNR was 0.17 (low, 574 [71.8%]; intermediate, 170 [21.3%]; high, 55 [6.9%]). In univariate analysis, LNR showed significant association with a worse relapse-free survival (3-year relapse-free survival rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; p < 0.001, log-rank test). In multivariate analysis, LNR did not show significant association with recurrence after adjusting for other clinical factors (age, histologic grade, subtype, ypT stage, ypN stage, lymphatic or vascular invasion, and pCR). In subgroup analysis, the LNR system had good prognostic value in HR+/HER2- subtype.Conclusion LNR is not superior to ypN stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy. However, the prognostic value of the LNR system in HR+/HER2- patients is notable and worthy of further investigation.

Original languageEnglish
Pages (from-to)1373-1381
Number of pages9
JournalCancer Research and Treatment
Volume48
Issue number4
DOIs
Publication statusPublished - 2016 Jan 1

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docetaxel
Doxorubicin
Cyclophosphamide
Cohort Studies
Retrospective Studies
Breast Neoplasms
Drug Therapy
Lymph Nodes
Hormones
Recurrence
Triple Negative Breast Neoplasms
Age Factors
Blood Vessels
Breast
Multivariate Analysis
Survival Rate
Survival
human ERBB2 protein

Keywords

  • Breast neoplasms
  • Lymph node excision
  • Lymph nodes
  • Neoadjuvant therapy
  • Prognosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Prognostic value of axillary nodal ratio after neoadjuvant chemotherapy of doxorubicin/cyclophosphamide followed by docetaxel in breast cancer : A multicenter retrospective cohort study. / Kim, Se Hyun; Jung, Kyung Hae; Kim, Tae Yong; Im, Seock Ah; Choi, In Sil; Chae, Yee Soo; Baek, Sun Kyung; Kang, Seok Yun; Park, Sarah; Park, In Hae; Lee, Keun Seok; Choi, Yoon Ji; Lee, Soohyeon; Sohn, Joo Hyuk; Park, Yeon Hee; Im, Young Hyuck; Ahn, Jin Hee; Kim, Sung Bae; Kim, Jee Hyun.

In: Cancer Research and Treatment, Vol. 48, No. 4, 01.01.2016, p. 1373-1381.

Research output: Contribution to journalArticle

Kim, SH, Jung, KH, Kim, TY, Im, SA, Choi, IS, Chae, YS, Baek, SK, Kang, SY, Park, S, Park, IH, Lee, KS, Choi, YJ, Lee, S, Sohn, JH, Park, YH, Im, YH, Ahn, JH, Kim, SB & Kim, JH 2016, 'Prognostic value of axillary nodal ratio after neoadjuvant chemotherapy of doxorubicin/cyclophosphamide followed by docetaxel in breast cancer: A multicenter retrospective cohort study', Cancer Research and Treatment, vol. 48, no. 4, pp. 1373-1381. https://doi.org/10.4143/crt.2015.475
Kim, Se Hyun ; Jung, Kyung Hae ; Kim, Tae Yong ; Im, Seock Ah ; Choi, In Sil ; Chae, Yee Soo ; Baek, Sun Kyung ; Kang, Seok Yun ; Park, Sarah ; Park, In Hae ; Lee, Keun Seok ; Choi, Yoon Ji ; Lee, Soohyeon ; Sohn, Joo Hyuk ; Park, Yeon Hee ; Im, Young Hyuck ; Ahn, Jin Hee ; Kim, Sung Bae ; Kim, Jee Hyun. / Prognostic value of axillary nodal ratio after neoadjuvant chemotherapy of doxorubicin/cyclophosphamide followed by docetaxel in breast cancer : A multicenter retrospective cohort study. In: Cancer Research and Treatment. 2016 ; Vol. 48, No. 4. pp. 1373-1381.
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title = "Prognostic value of axillary nodal ratio after neoadjuvant chemotherapy of doxorubicin/cyclophosphamide followed by docetaxel in breast cancer: A multicenter retrospective cohort study",
abstract = "Purpose The purpose of this study is to investigate the prognostic value of lymph node (LN) ratio (LNR) in patients with breast cancer after neoadjuvant chemotherapy. Materials and Methods This retrospective analysis is based on the data of 814 patients with stage II/III breast cancer treated with four cycles of doxorubicin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical significance of LNR (3 categories: low 0-0.20 vs. intermediate 0.21-0.65 vs. high 0.66-1.00) using a Cox proportional regression model. Results A total of 799 patients underwent breast surgery. Pathologic complete response (pCR, ypT0/isN0) was achieved in 129 patients (16.1{\%}) (hormone receptor [HR] +/human epidermal growth factor receptor 2 [HER2] -, 34/373 [9.1{\%}]; HER2+, 45/210 [21.4{\%}]; triple negative breast cancer, 50/216 [23.1{\%}]). The mean numbers of involved LN and retrieved LN were 2.70 (range, 0 to 42) and 13.98 (range, 1 to 64), respectively. The mean LNR was 0.17 (low, 574 [71.8{\%}]; intermediate, 170 [21.3{\%}]; high, 55 [6.9{\%}]). In univariate analysis, LNR showed significant association with a worse relapse-free survival (3-year relapse-free survival rate 84.8{\%} in low vs. 66.2{\%} in intermediate vs. 54.3{\%} in high; p < 0.001, log-rank test). In multivariate analysis, LNR did not show significant association with recurrence after adjusting for other clinical factors (age, histologic grade, subtype, ypT stage, ypN stage, lymphatic or vascular invasion, and pCR). In subgroup analysis, the LNR system had good prognostic value in HR+/HER2- subtype.Conclusion LNR is not superior to ypN stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy. However, the prognostic value of the LNR system in HR+/HER2- patients is notable and worthy of further investigation.",
keywords = "Breast neoplasms, Lymph node excision, Lymph nodes, Neoadjuvant therapy, Prognosis",
author = "Kim, {Se Hyun} and Jung, {Kyung Hae} and Kim, {Tae Yong} and Im, {Seock Ah} and Choi, {In Sil} and Chae, {Yee Soo} and Baek, {Sun Kyung} and Kang, {Seok Yun} and Sarah Park and Park, {In Hae} and Lee, {Keun Seok} and Choi, {Yoon Ji} and Soohyeon Lee and Sohn, {Joo Hyuk} and Park, {Yeon Hee} and Im, {Young Hyuck} and Ahn, {Jin Hee} and Kim, {Sung Bae} and Kim, {Jee Hyun}",
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day = "1",
doi = "10.4143/crt.2015.475",
language = "English",
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TY - JOUR

T1 - Prognostic value of axillary nodal ratio after neoadjuvant chemotherapy of doxorubicin/cyclophosphamide followed by docetaxel in breast cancer

T2 - A multicenter retrospective cohort study

AU - Kim, Se Hyun

AU - Jung, Kyung Hae

AU - Kim, Tae Yong

AU - Im, Seock Ah

AU - Choi, In Sil

AU - Chae, Yee Soo

AU - Baek, Sun Kyung

AU - Kang, Seok Yun

AU - Park, Sarah

AU - Park, In Hae

AU - Lee, Keun Seok

AU - Choi, Yoon Ji

AU - Lee, Soohyeon

AU - Sohn, Joo Hyuk

AU - Park, Yeon Hee

AU - Im, Young Hyuck

AU - Ahn, Jin Hee

AU - Kim, Sung Bae

AU - Kim, Jee Hyun

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Purpose The purpose of this study is to investigate the prognostic value of lymph node (LN) ratio (LNR) in patients with breast cancer after neoadjuvant chemotherapy. Materials and Methods This retrospective analysis is based on the data of 814 patients with stage II/III breast cancer treated with four cycles of doxorubicin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical significance of LNR (3 categories: low 0-0.20 vs. intermediate 0.21-0.65 vs. high 0.66-1.00) using a Cox proportional regression model. Results A total of 799 patients underwent breast surgery. Pathologic complete response (pCR, ypT0/isN0) was achieved in 129 patients (16.1%) (hormone receptor [HR] +/human epidermal growth factor receptor 2 [HER2] -, 34/373 [9.1%]; HER2+, 45/210 [21.4%]; triple negative breast cancer, 50/216 [23.1%]). The mean numbers of involved LN and retrieved LN were 2.70 (range, 0 to 42) and 13.98 (range, 1 to 64), respectively. The mean LNR was 0.17 (low, 574 [71.8%]; intermediate, 170 [21.3%]; high, 55 [6.9%]). In univariate analysis, LNR showed significant association with a worse relapse-free survival (3-year relapse-free survival rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; p < 0.001, log-rank test). In multivariate analysis, LNR did not show significant association with recurrence after adjusting for other clinical factors (age, histologic grade, subtype, ypT stage, ypN stage, lymphatic or vascular invasion, and pCR). In subgroup analysis, the LNR system had good prognostic value in HR+/HER2- subtype.Conclusion LNR is not superior to ypN stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy. However, the prognostic value of the LNR system in HR+/HER2- patients is notable and worthy of further investigation.

AB - Purpose The purpose of this study is to investigate the prognostic value of lymph node (LN) ratio (LNR) in patients with breast cancer after neoadjuvant chemotherapy. Materials and Methods This retrospective analysis is based on the data of 814 patients with stage II/III breast cancer treated with four cycles of doxorubicin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical significance of LNR (3 categories: low 0-0.20 vs. intermediate 0.21-0.65 vs. high 0.66-1.00) using a Cox proportional regression model. Results A total of 799 patients underwent breast surgery. Pathologic complete response (pCR, ypT0/isN0) was achieved in 129 patients (16.1%) (hormone receptor [HR] +/human epidermal growth factor receptor 2 [HER2] -, 34/373 [9.1%]; HER2+, 45/210 [21.4%]; triple negative breast cancer, 50/216 [23.1%]). The mean numbers of involved LN and retrieved LN were 2.70 (range, 0 to 42) and 13.98 (range, 1 to 64), respectively. The mean LNR was 0.17 (low, 574 [71.8%]; intermediate, 170 [21.3%]; high, 55 [6.9%]). In univariate analysis, LNR showed significant association with a worse relapse-free survival (3-year relapse-free survival rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; p < 0.001, log-rank test). In multivariate analysis, LNR did not show significant association with recurrence after adjusting for other clinical factors (age, histologic grade, subtype, ypT stage, ypN stage, lymphatic or vascular invasion, and pCR). In subgroup analysis, the LNR system had good prognostic value in HR+/HER2- subtype.Conclusion LNR is not superior to ypN stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy. However, the prognostic value of the LNR system in HR+/HER2- patients is notable and worthy of further investigation.

KW - Breast neoplasms

KW - Lymph node excision

KW - Lymph nodes

KW - Neoadjuvant therapy

KW - Prognosis

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DO - 10.4143/crt.2015.475

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